If You Build It, They Will Come: Robert Negrin Shares His Vision for Blood Advances

Sunday, May 1, 2016

When Robert Negrin, MD, was growing up in Silver Spring, Maryland, if someone had told his parents that their son would one day become a professor of medicine, they “would have just laughed,” Dr. Negrin explained. “I had no interest in science as a kid. I actually wanted to be a baseball player – until I realized that I wasn’t any good at baseball.”

While Dr. Negrin’s field of dreams may have faded away, he has, to keep the analogy going, been batting a thousand as a practicing hematologist and researcher. Since the mid-1980s, Dr. Negrin has held various key positions at Stanford University Medical Center in California, including his current role as chief of the Division of Blood and Marrow Transplantation.

He has also served as an associate editor of Blood since 2010, and this year Dr. Negrin took on the role of founding editor-in-chief of Blood Advances, a new publication from the American Society of Hematology (ASH).

Blood Advances will begin accepting submissions for publication in late summer, and the journal is scheduled to debut at the 58th ASH Annual Meeting in San Diego in December. The inaugural issue will be both print and online, but after that, the journal will be strictly online.

“After 70 years of excellence in Blood, the intersection of technological innovation and rapid scientific discovery in hematology makes now the perfect time for ASH to introduce this new journal,” said 2016 ASH President Charles S. Abrams, MD, of the University of Pennsylvania in Philadelphia, in a written statement. “Blood Advances will complement ASH’s outstanding portfolio of high-caliber scientific and clinical publications and set a new standard in electronic publishing.”

Dr. Negrin spoke with ASH Clinical News about his vision for Blood Advances, as well as the road he has traveled during his more than 30 years in medicine.

Bringing Science to the People

Dr. Negrin earned a bachelor’s degree in biochemistry from the University of California Berkeley in 1977, then completed a graduate program in physiological chemistry at the University of Wisconsin in Madison. At that point, Dr. Negrin was keen on basic science.

“I didn’t really want to get into medicine,” he said. “I was not that interested in being a doctor because I thought medicine was for competitive people. So, I decided to be a biochemist.”

But it was during a celebration of what should have been a highlight in his burgeoning research career when Dr. Negrin realized basic science may not be the right choice for him. He and his fellow students had just gotten a paper accepted by the Journal of Biological Chemistry in 1980. “I distinctly remember that moment. We were at a pub in Wisconsin – that’s what you did when you got a paper accepted to a good journal – and I remember talking with my graduate instructor and saying that I wasn’t that interested in the topic we were studying, which was the ATPase of Escherichia coli. It was just too narrow,” he said. “I had achieved some success in the lab, and I just wasn’t satisfied with that feeling – it wasn’t impactful enough.”

Dr. Negrin emphasized that he understands and appreciates the importance of basic science, but it simply wasn’t a home run for him. What was missing? The connection to people.

“We all have to recognize how we want to spend our time. For me, it wasn’t enough to answer the question posed in the research; it had to be a question that was important to me,” he said. “I fully recognize any basic science is ultimately connected to people, but I needed to answer questions that had a more direct connection. That’s been a guiding principle for me.”

That guiding principle took him to Harvard Medical School in Boston, Massachusetts, where he earned a medical degree in 1984. At that point, Dr. Negrin was deciding between hematology and infectious disease. The former won out, with a residency and a hematology fellowship at Stanford.

But Dr. Negrin didn’t give up his basic science roots entirely. In fact, one of his initial impressions of medical school was that the curriculum “was too broad. It was sort of like Goldilocks and the Three Bears – I had to find my niche,” he explained. “Ultimately, I found that what I enjoyed was being at the interface of science and medicine.”

It’s the bench-to-bedside paradigm in medicine that “constantly amazes and awes” Dr. Negrin. “I love that interaction between what we think we need to do to conduct an experiment well, and then translating that into the clinic. Those are the ‘a-ha’ moments when we realize how much we can impact these patients’ situations.”

Asked about how the process of translational science has changed over the years, Dr. Negrin cited the growing importance of teamwork.

“Medicine is getting more complex, and we need different expertise to bring it all together,” he said. “As with any team, different players have different positions and that’s a good thing. The group is better than the sum of its parts.”

“I’m still a sports enthusiast, and I drive my wife crazy with that, but I love the concept of an effective team,” he added.

A Hub for Hematology

Dr. Negrin hopes to bring that team environment to Blood Advances.

“The Blood Advances site will provide a platform for hematologists to interact and communicate with one another through discussion boards, videos, podcasts, live chats, and interaction with the study authors — things you can’t do with a [traditional] journal,” Dr. Negrin explained.

His goal is to make Blood Advances a hub for hematologists to virtually interact with each other, almost on a real-time basis. For instance, a letter to the editor sent to a traditional journal will take time for editing, review, and publication. Months can go by before the letter is published and the study authors get a chance to respond. Readers will have the opportunity to comment on a study, or pose a question to the authors online, who will then have the chance to respond on a much faster timeline.

The vision statement for Blood Advances describes the peer-reviewed journal as providing “novel approaches for presentation of original content, including approaches that can only be performed using an electronic format, including enhanced graphics, video, and discussion.”

Additionally, Blood Advances will “attempt to complement Blood by publishing content not currently covered, including case reports, point-counterpoint discussions, and the ability to comment on published material readily.”

While those are lofty and laudable goals, the question remains, “Does medicine, and hematology in particular, need another journal?” Yes, according to Dr. Negrin, but not just any standard journal.

“I think journals are an important and critical way that we communicate, but they are not an interactive, dynamic tool,” he noted. “They certainly have their place, but they don’t necessarily fit in as well with the way we communicate these days.”

Blood Advances will consider papers that may not have been a good fit for Blood, but are still scientifically valid, he said.

“All of us have seen the explosion of really interesting science and clinical work in the field,” said Dr. Negrin. “The goal with Blood Advances is to capture that within the hematology community.”

And it’s not just traditional studies or meta-analyses that Blood Advances will consider. Dr. Negrin would like to see his colleagues propose ideas for live chats, video presentations, podcasts, or blog posts. He said the journal will also be open to trying novel ways of sharing information and encouraging professional exchanges.

“I’d like to use it as an incubator for trying new things – for instance, how reviewers interact with each other as they oversee a manuscript,” he explained. “Clearly, not all of these ideas will work, but I’d like to have the opportunity for people to experiment.”

However, he added, Blood Advances will be monitored to ensure users maintain “professional decorum.”

Finally, Blood Advances will specifically target hematologists in developing nations, an issue that is personally important to Dr. Negrin, who has traveled to Cambodia a number of times to work in local medical clinics.

Among Cambodian health-care professionals, the enthusiasm for and interest in offering better medicine to their patients – even though they had limited access to scientific data and know-how – impressed Dr. Negrin. He noted that “everybody had smartphones and everybody had the internet, yet many journals were out of reach – often for financial reasons and occasionally due to a lack of access. I wondered if there could be a way we could communicate with each other globally, on a more direct level.”

Possible avenues for that communication could be discussion groups to review difficult-to-treat cases or live question-and-answer and “How I Do It” sessions. “If we can create the right forum, then there is no reason that we can’t all learn from each other,” he said.

Once again, it’s back to baseball – Blood Advances is the team that Dr. Negrin hopes all hematologists will want to play for.

“I’m excited to be able to lead this effort, to use this online format to do some things that you can’t do with a print journal, and to help develop that clinical team concept,” he said.